Using digital health to facilitate compliance with standardized pediatric cancer treatment guidelines in Tanzania: protocol for an early-stage effectiveness-implementation hybrid study

Abstract

Background: In high-income countries (HICs), increased rates of survival among pediatric cancer patients are achieved through the use of protocol-driven treatment. Compared to HICs, differences in infrastructure, supportive care, and human resources, make compliance with protocol-driven treatment challenging in low-and middleincome countries (LMICs). For successful implementation of protocol-driven treatment, treatment protocols must be resource-adapted for the LMIC context, and additional supportive tools must be developed to promote protocol compliance. In Tanzania, an LMIC where resource-adapted treatment protocols are available, digital health applications could promote protocol compliance through incorporation of systematic decision support algorithms, reminders and alerts related to patient visits, and up-to-date data for care coordination. However, evidence on the use of digital health applications in improving compliance with protocol-driven treatment for pediatric cancer is limited. This study protocol describes the development and evaluation of a digital health application, called mNavigator, to facilitate compliance with protocol-driven treatment for pediatric cancer in Tanzania. Methods: mNavigator is a digital case management system that incorporates nationally-approved and resourceadapted treatment protocols for two pediatric cancers in Tanzania, Burkitt lymphoma and retinoblastoma. mNavigator is developed from an open-source digital health platform, called CommCare, and guided by the Consolidated Framework for Implementation Research. From July 2019-July 2020 at Bugando Medical Centre in Mwanza, Tanzania, all new pediatric cancer patients will be registered and managed using mNavigator as the new standard of care for patient intake and outcome assessment. Pediatric cancer patients with a clinical diagnosis of Burkitt lymphoma or retinoblastoma will be approached for participation in the study evaluating mNavigator. mNavigator users will document pre-treatment and treatment details for study participants using digital forms and checklists that facilitate compliance with protocol-driven treatment. Compliance with treatment protocols using mNavigator will be compared to historical compliance rates as the primary outcome. Throughout the implementation period, we will document factors that facilitate or inhibit mNavigator implementation.

Global retinoblastoma survival and globe preservation: a systematic review and meta-analysis of associations with socioeconomic and health-care factors

“…80 It is important to help parents to identify red-flag symptoms and encourage their use of patient support services. Other successful approaches include expanding the capacities of telemedicine and cloud-based health record systems (eg, mNavigator in Tanzania), 81 developing low-cost screening systems based on artificial intelligence (eg, MDEyeCare and CRADLE in the USA), 82,83 expanding primary care and health insurance coverage (Taiwan), 84 and twinning programmes to obtain more than doubled outcomes. 85 Moreover, prospective collection of uniform, multicentre, international retinoblastoma data and literature are helpful to raise awareness and guide government policy.…”

Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review

“…The study designs varied considerably ( Table 1 ); the most frequent designs were pre-post designs (15/42, 36%) and case studies or case series (11/42, 26%). There were 3 lower-middle–income countries, as defined by the World Bank [ 62 ] (Tunisia [ 63 , 64 ], Nepal [ 65 ], and Tanzania [ 66 ]) represented in the 42 included full-text studies.…”

“…A total of 45 separate CDSSs were reported in the 42 articles included as shown in Table 2 . The most commonly reported CDSSs were electronic prescribing or order sets (12/42, 29%) [ 65 , 69 , 70 , 75 , 76 , 79 - 81 , 83 , 88 , 94 , 98 ], followed by checklists, forms, or clinical guidelines (11/42, 26%) [ 63 , 66 , 73 , 82 , 89 , 92 , 93 , 95 , 102 , 104 ] and electronic alerts or reminders (9/42, 21%) [ 67 , 68 , 77 , 78 , 84 , 86 , 91 , 100 , 101 ]. Commonly, CDSSs were implemented in pharmacy or prescription services (17/42, 41%).…”

“…Other rationales cited for implementing a CDSS included the following: the CDSS as a separate intervention to address a clinical need or context (eg, reducing the incidence of hospital-acquired infections [ 64 ]), increasing workflow efficacy [ 79 ], improving adherence to clinical guidelines [ 82 ], transforming time-consuming paper versions of a CDSS to a digital version [ 81 , 87 , 104 ], engaging or collaborating with health care workers [ 78 ], and decreasing duplication of tests or health resource waste (eg, duplicates of magnetic resonance imaging scans) [ 84 ]. Other authors noted that their study was a scale-up or modification of an initial pilot of a CDSS [ 80 , 82 , 98 ], that there was existing evidence that validated the use of a CDSS [ 66 ], and contextual factors of the health system (eg, rapid turnover of clinicians) required the implementation of a CDSS [ 70 ].…”

A di-electrophoretic simulation procedure of iron-oxide micro-particle drug attachment system for leukemia treatment using COMSOL software: a potential treatment reference for LMICs

“…As compared to other treatment methods, many researchers have highlighted Modeling and Simulation Approaches (MSAs) as phenomenal approaches in targeting leukemia cells (13)(14)(15)(16). These approaches have provided early detection techniques which are key factors in cancer treatment hence leading to long-term cancer survival for patients from the western world (17)(18)(19)(20)(21). Although many of these approaches involve in vitro and in vivo tools, computational tools have also emerged as preparatory tools capable of providing deeper insight than in vitro/in vivo tools (22,23).…”